Brucella Septic Hip Arthritis: A Case Report

Jahmani, Rami; Obeidat, Omar; Yusef, Dawood

doi:10.12659/ajcr.928592

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…In contrast to our nding, some studies reported the predominance of lymphocytes in the synovial uid (37,38).It should be noted that the sample size of all the studies mentioned was smaller than our study. In general, even in the presence of a negative culture for Brucella organism, septic involvement cannot be de nitively ruled out; therefore, synovial biopsy is an invasive procedure and that is mostly unnecessary (39). If a cutoff of 50,000 cells/mm 3 is accepted for septic arthritis, our samples indicated reactive involvement.…”

Section: Discussionmentioning

confidence: 95%

Brucellar arthritis and sacroiliitis: an eight-year retrospective comparative analysis of demographic, clinical and paracilinical features

Sayad

Bozorgomid

Mohammadi

et al. 2022

Preprint

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Background Brucellosis is a common global zoonotic disease with a wide range of complex and non-specific clinical manifestations that may lead to misdiagnosis and delayed treatment. Osteoarticular involvement is the most common complaint in brucellosis. Methods This retrospective descriptive study was performed on patients presenting to a teaching hospital in Kermanshah, Iran with a diagnosis of brucellosis during 2011–2019. The demographic and clinical characteristics, complications, laboratory findings and treatment were recorded during the study period. Then, the difference in the collected data was investigated between brucellosis patients with and without arthritis or sacroiliitis. Results Of 425 patients, 130 (30.58%) had osteoarticular involvement. Sacroiliitis (13.6%) followed by spondylitis (12.9%) and peripheral arthritis (9.6%) was the most common type of complication. 15% of patients with Sacroillitis had spondylitis, concomitantly. There were no significant demographic differences between patients with and without brucellar arthritis or sacroiliitis. The patients with brucellar arthritis had a significantly higher frequency of arthralgia. Arthralgia, neck pain, back pain, positive Faber test, radiculopathy and vertebral tenderness were significantly more frequent in patients with Sacroiliitis; while fever and headache were significantly more common in patients without sacroiliitis. The median wright and 2ME titers were higher in brucellosis patients with arthritis or sacroiliitis versus patients without arthritis or sacroiliitis, but the difference was not significant. Synovial fluid was analyzed in 20 cases. The mean white cell count, glucose and protein level were 3461 ± 2.70, 58.54 ± 31.43 mg/dLit and 8.6 ± 11.85 g/dLit, respectively. Neutrophil cells were predominant in 80% of samples. patients with arthritis had a higher median platelet count and patients with sacroiliitis had higher median levels of AST and ALP significantly. Conclusions Arthritis and sacroiliitis had a frequency of 9.64% and 13.6%, respectively. Any complaints of low back pain and radiculopathy as well as the presence of spondylitis in patients should raise suspicion of sacroiliitis. High levels of ALP and a high platelet count may be associated with brucellar sacroiliitis and arthritis, respectively. The use of paraclinical methods such as MRI and bone scan seems necessary for diagnosis of sacroiliitis.

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Section: Discussionmentioning

confidence: 95%

Brucellar arthritis and sacroiliitis: an eight-year retrospective comparative analysis of demographic, clinical and paracilinical features

Sayad

Bozorgomid

Mohammadi

et al. 2022

Preprint

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“…In general, even in the presence of a negative culture for Brucella organism, septic involvement cannot be definitively ruled out; therefore, synovial biopsy is an invasive procedure that is mostly unnecessary. 44 If a cutoff of 50,000 cells/mm 3 is accepted for septic arthritis, our samples indicated reactive involvement. It should be noted that the synovial fluid Wright test titer was positive in two cases, which confirms a reactive involvement although this cutoff was questioned recently.…”

Section: Discussionmentioning

confidence: 98%

Brucellar arthritis and sacroiliitis: an 8-year retrospective comparative analysis of demographic, clinical, and paraclinical features

Morovati,

Bozorgomid,

Mohammadi

et al. 2024

Therapeutic Advances in Infection

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Introduction: Brucellosis is a common global zoonotic disease with a wide range of complex and nonspecific clinical manifestations that may lead to misdiagnosis and delayed treatment. Osteoarticular involvement is the most common complaint in brucellosis. Objective: This present study aims to describe the clinical and laboratory characteristics and treatment of brucellosis patients with arthritis and sacroiliitis. Methods: This retrospective descriptive study was performed on patients presenting to a teaching hospital in Kermanshah, Iran with a diagnosis of brucellosis from 2011 to 2019. The demographic and clinical characteristics, complications, laboratory findings, and treatment were recorded during the study period. Then, the difference in the collected data was investigated between brucellosis patients with and without arthritis or sacroiliitis. Results: Of 425 patients studied, 130 (30.58%) had osteoarticular involvement. Among them, 41 (9.64%) and 58 (13.6%) patients were diagnosed with arthritis and sacroiliitis, respectively. There were no significant demographic differences between patients with and without brucellar arthritis or sacroiliitis ( p > 0.05). The patients with Brucella arthritis had a significantly higher frequency of arthralgia and radiculopathy ( p ⩽ 0.05). Sacroiliitis was significantly more common in patients with arthralgia, neck pain, and low back pain, positive flexion-abduction-external rotation (FABER) test, radiculopathy, and vertebral tenderness compared to patients without sacroiliitis ( p ⩽ 0.05), while fever and headache were significantly more common in patients without sacroiliitis ( p ⩽ 0.05). The median Wright and 2-Mercapto Ethanol titers were higher in brucellosis patients with arthritis or sacroiliitis versus patients without arthritis or sacroiliitis, but the difference was not significant ( p > 0.05). Synovial fluid had been analyzed in 20 cases. The mean white blood cell count, glucose, and protein level were 3461 ± 2.70 cells/mm3, 58.54 ± 31.43 mg/dL, and 8.6 ± 11.85 g/dL, respectively. In 80% of the subjects, neutrophil cells were predominant. There were no significant laboratory differences between patients with and without brucellar arthritis or sacroiliitis, except for a higher median platelet count in patients with arthritis and higher median levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in patients with sacroiliitis. Most cases of arthritis and sacroiliitis were diagnosed with ultrasound (31.8%) and FABER test (79.3%), respectively. Conclusion: Arthritis and sacroiliitis were the two most important and common manifestations of brucellar osteoarthritis with a frequency of 9.64% and 13.6%, respectively. Any complaints of low back pain and radiculopathy as well as the presence of spondylitis in patients should raise suspicion of sacroiliitis. High levels of AST and ALP and a high platelet count may be associated with brucellar sacroiliitis and arthritis, respectively. The use of imaging methods such as MRI and bone scan seems necessary for the diagnosis of sacroiliitis.

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“…Physical examination showed deep tenderness and percussive pain at the lesion site, accompanied by a positive Tomas sign and positive "4" test; diagnosis and treatment are challenging. Delayed treatment can lead to severe complications, such as femoral head dislocation and ischemic necrosis (Jahmani et al, 2021). Shoulder arthritis is common in the elderly, with symptoms lasting long and often requiring an extended period to recover from joint damage.…”

Section: Motion-osteoarticular Systemmentioning

confidence: 99%

Research progress on complications of Brucellosis

Jun

Fan

Gao

et al. 2023

Front. Cell. Infect. Microbiol.

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Brucellosis is a common zoonotic disease that is widely spread worldwide and poses a major threat to human health. Clinically, it often presents with non-specific symptoms such as fever, excessive sweating, malaise, myalgia, arthralgia, loss of appetite, weight loss, and enlarged liver, spleen and lymph nodes. The disease has a long and recurrent course, often accumulating in multiple systems and organs. Of these, osteoarticular involvement is the most common complication, with a prevalence of approximately 2-77%, usually manifesting as spondylitis, sacroiliac arthritis and peripheral arthritis. Hepatosplenomegaly is seen in about 50% of patients with brucellosis, and gastrointestinal disturbances such as abdominal pain, nausea, and vomiting are common. Although respiratory involvement is less common, pneumonia, pleurisy, pleural effusion, and pulmonary nodules have been reported. Besides, approximately 2-20% of cases involve infections of the male genitourinary system, mainly manifesting as unilateral epididymal-orchitis and orchitis. The most serious complication facing brucellosis is cardiovascular involvement, and although the overall mortality rate of brucellosis is about 1% and the incidence of brucellosis endocarditis is less than 2%, more than 80% of deaths are associated with endocarditis. Furthermore, brucellosis is complicated by hematologic disease, with anemia occurring in approximately 20-53% of children during the acute phase. In addition, the neurological incidence of brucellosis is about 0.5-25%, mainly manifested as meningitis. In this study, we review the multisystem complications of brucellosis with the aim of improving early diagnosis, timely treatment and prevention of long-term complications.

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Brucella Septic Hip Arthritis: A Case Report

Cited by 4 publications

References 6 publications

Brucellar arthritis and sacroiliitis: an eight-year retrospective comparative analysis of demographic, clinical and paracilinical features

Brucellar arthritis and sacroiliitis: an eight-year retrospective comparative analysis of demographic, clinical and paracilinical features

Brucellar arthritis and sacroiliitis: an 8-year retrospective comparative analysis of demographic, clinical, and paraclinical features

Research progress on complications of Brucellosis

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